Does Medicare Part D cover Promacta?
Promacta appears on the Medicare Part D formularies of 19 payers in the corpus, across 1,074 plans. 19 payers require prior authorization on every covering plan, 0 on some plans, and 0 on none.
Beyond prior authorization: 0 covering plans require step therapy (another drug tried first) and 1,072 apply a quantity limit, on at least one Promacta product.
Prior authorization is set per plan, not per payer. Pick a payer below for its full plan-by-plan breakdown, effective 2026-06-30.
Coverage by payer
| Payer | Plans covering | Require prior auth | Step therapy | Quantity limit | Status |
|---|---|---|---|---|---|
| Humana | 817 | 817 | 0 | 817 | Prior authorization required |
| SCAN Health Plan | 74 | 74 | 0 | 74 | Prior authorization required |
| Cariten Health Plan INC. | 44 | 44 | 0 | 44 | Prior authorization required |
| Careplus Health Plans, INC. | 36 | 36 | 0 | 36 | Prior authorization required |
| Mcs Advantage, INC. | 20 | 20 | 0 | 20 | Prior authorization required |
| Excellus Health Plan, INC. | 16 | 16 | 0 | 16 | Prior authorization required |
| Prominence Healthfirst Of Texas | 13 | 13 | 0 | 13 | Prior authorization required |
| Aetna (CVS Health) | 10 | 10 | 0 | 10 | Prior authorization required |
| Keystone Health Plan East, INC. | 8 | 8 | 0 | 8 | Prior authorization required |
| Prominence Healthfirst | 8 | 8 | 0 | 8 | Prior authorization required |
| Prominence Healthfirst Of Florida INC | 5 | 5 | 0 | 5 | Prior authorization required |
| Health New England, INC. | 4 | 4 | 0 | 4 | Prior authorization required |
| Qcc Insurance Company | 4 | 4 | 0 | 4 | Prior authorization required |
| Leon Health, INC. | 4 | 4 | 0 | 4 | Prior authorization required |
| Capital District Physicians' Health Plan, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Amerihealth Insurance Company Of New Jersey | 3 | 3 | 0 | 3 | Prior authorization required |
| Hamaspik, INC. | 2 | 2 | 0 | 0 | Prior authorization required |
| Excellus Health Plan Community Care LLC | 2 | 2 | 0 | 2 | Prior authorization required |
| Independent Care Health Plan | 1 | 1 | 0 | 1 | Prior authorization required |
“Require prior auth”, “step therapy” and “quantity limit” each count a plan when any Promacta product on its formulary carries that condition.
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.